Risk stratification in individuals with the Brugada type 1 ECG pattern without previous cardiac arrest: usefulness of a combined clinical and electrophysiologic approach
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AIMS: Risk stratification in individuals with type 1 Brugada electrocardiogram (ECG) pattern (type 1 ECG) for primary prevention of sudden death (SD). METHODS AND RESULTS: Three hundred and twenty patients (258 males, median age 43 years) with type 1 ECG were enrolled. No patient had previous cardiac arrest. Fifty-four per cent of patients had a spontaneous and 46% a drug-induced type 1 ECG. One-third had syncope, two-thirds were asymptomatic. Two hundred and forty-five patients underwent electrophysiologic study (EPS) and 110 patients received an implantable cardiac defibrillator (ICD). During follow-up [median length 40 months (IQ20-67)], 17 patients had major arrhythmic events (MAE) (14 resuscitated ventricular fibrillation (VF) and three SD). Both a spontaneous type 1 ECG and syncope significantly increased the risk (2.6 and 3.0% event rate per year vs. 0.4 and 0.8%). Major arrhythmic events occurred in 14% of subjects with positive EPS, in no subjects with negative EPS and in 5.3% of subjects without EPS. All MAE occurred in subjects who had at least two potential risk factors (syncope, family history of SD, and positive EPS). Among these patients, those with spontaneous type 1 ECG had a 30% event rate. CONCLUSION: (1) In subjects with the Brugada type 1 ECG, no single clinical risk factor, nor EPS alone, is able to identify subjects at highest risk; (2) a multiparametric approach (including syncope, family history of SD, and positive EPS) helps to identify populations at highest risk; (3) subjects at highest risk are those with a spontaneous type 1 ECG and at least two risk factors; (4) the remainder are at low risk.
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A drug-induced type 1 ECG pattern has a lower risk of sudden death than a spontaneous type 1 response in Brugada syndrome.
“A drug-induced type 1 ECG pattern has a lower risk of sudden death than a spontaneous type 1 response.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [367]
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2018 ESC Guidelines for the diagnosis and management of syncope
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Self-citation
- Authors
- Delise, P., Allocca, G., Marras, E., Giustetto, C., Gaita, F., Sciarra, L., Calo, L., Proclemer, A., Marziali, M., Rebellato, L., Berton, G., Coro, L., & Sitta, N.
- Affiliations
- Azienda Sanitaria Locale di Asti (IT)
- Policlinico Casilino (IT)
- Ospedale Santa Maria della Misericordia di Udine (IT)
- Corresponding author
- Delise, P.
- Allocca, G.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-10-26
- Volume
- 32
- Issue
- 2
- Pages
- 169-176
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC3021386
- OpenAlex
- W2146214743
- Cited by
- 221
- References
- 29
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 12 · 2023: 9 · 2022: 12 · 2021: 19 · 2020: 16 · 2019: 16 · 2018: 13 · 2017: 25 · 2016: 24 · 2015: 16 · 2014: 4 · 2013: 18 · 2012: 12
- FWCI
- 9.45
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- European Heart Journal (publishedVersion, other-oa)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
- Archivio Istituzionale della Ricerca - Università degli Studi dell Aquila (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- Brugada syndrome, sudden cardiac death, risk stratification, syncope, implantable cardioverter-defibrillator, electrophysiological study, family history of sudden death, ventricular fibrillation, primary prevention, major arrhythmic events
- MeSH terms
- Adult, Electrocardiography, Female, Heart Arrest, Humans, Male, Middle Aged, Pedigree, Prospective Studies, Risk Factors, Syncope, Ventricular Fibrillation, Death, Sudden, Cardiac, Treatment Outcome, Defibrillators, Implantable, Risk Assessment, Electrophysiologic Techniques, Cardiac, Kaplan-Meier Estimate, Brugada Syndrome
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